Radiological Preparedness Case Studies: Training for Accidents Dirty Bombs

1. Radiological Preparedness Case Studies: Training for Accidents & Dirty Bombs Carl Schopfer Carl.Schopfer@UMDNJ.edu

2. How to Educate a Diverse Population? Health officers Environmental health specialists Emergency Response groups Infection control professionals Epidemiologists Health educators Higher education professionals Mental Health responders Volunteer disaster response groups Employees of industrial facilities Law enforcement

3. Various Training Approaches Didactic Training Web-Based Courses Distance Education Modules Lectures, Seminars & Workshops Case-Based Curriculum Development Use for students with diverse learning levels Allow students to focus on different aspects Emphasizes skills over facts learned Advantage for adult students Rated high for future relevance and skills

4. Why Study Accidents to Prepare for Terror? Fortunately, no radiological attacks�..Yet Major accidents involve several groups: Governments Emergency Services Public Outside Technical Experts Media Healthcare Community These groups interact in complex ways There is a need for quick & accurate response

5. Case Study - Three Mile Island Learn the rationale for a KI distribution plan and the risks and benefits of implementation Describe on what points to counsel patients and public about radiation risk Understand the concepts behind the terms radiation exposure, absorbed dose, dose equivalent, collective DE Identify reliable sources of information Identify populations at risk

6. Case study - Chernobyl Describe how to identify acute radiation syndrome Distinguish between �external� and �internal� contamination Learn the basics of management of radiological casualties Identify specialized state and federal radiation response resources Advice to give on monitoring and decontamination of people, equipment, property and the environment

7. Case Study - Goiania Describe how the public should be informed of hazardous areas, and of protective actions How to address protection of the water and food supply How to address mass concern, mental health and behavioral health issues Explain the basics of radiation background Distinguish between �external� and �internal� contamination Describe �how clean is clean,� and what is a �safe dose level�

8. What is the Terror Threat? Radiological Dispersion Device (RDD) �Dirty Bomb� - conventional explosive disperses material Doesn�t have heat, blast, prompt radiation effects of nuclear bomb Covert Placement or Dispersal Placement of high-intensity source Simple contamination or poisoning Sabotage of Nuclear Power, Transport or Storage Facility Improvised Nuclear Device or Actual Weapon �Suitcase Nukes� Use of fissile material to initiate fission reaction Other device to disperse radioactive material

9. Radiological & Nuclear Weapons Availability Nuclear Weapons require resources of a nation Is �high tech�, but accomplished in 1945 Can be stolen, perhaps bypass safeguards Would not have to be high-yield RDD � the �Next Best Thing� Considered in WWII and tested by Iraq in 1980s Military � an �area denial� weapon Simple construction, deployment Simple Dispersal or Placement Sabotage or Outright Attack

10. Weapons of Mass Destruction Attractive to Terrorists Have a high effect / resource ratio Use target organization resources against itself Can be done covertly, making deterrence difficult CBRNE are scary and useful against �soft� targets RDDs and Nuclear Attacks Nuclear weapon � large loss of life, physical damage and economic impact, and long-term radioactive contamination RDDs potentially economic impact, and long-term radioactive contamination

11. Radiological Terrorist Events: Izmailovo Park, Moscow Chechen insurgents place a dynamite/radiocesium device which did not explode (1996) Argun, Chechnya Suspected Chechen rebels deploy an explosive mine with unidentified radioactive material (1998) Chicago, USA Jose Padilla arrested on suspicion of planning to build and detonate a dirty bomb (2002) Herat, Afghanistan British Intelligence & weapons researchers conclude Al Qaeda succeeded in constructing a small dirty bomb (2003)

12. Radiological Accidents Windscale, U.K. (1957): Palomares, Spain (1966) Three Mile Island, USA (1979) Goiania, Brazil (1987) Chernobyl, USSR (1986) Tomsk, USSR (1993) Tokaimura, Japan (1999)

13. Radiological Dispersion Device The Department of Defense definition: "any device, including any weapon or equipment, other than a nuclear explosive device, specifically designed to employ radioactive material by disseminating it to cause destruction, damage, or injury by means of the radiation produced by the decay of such material.� Radiation presence may not be immediately obvious Unless strong source, prompt radiation injury unlikely Significant contamination of people and environment

14. Preparing for a Radiological Attack Enhance awareness of acute radiation symptoms and treatment among healthcare providers Educate first responder and healthcare providers on contamination and low-level radiation issues. Provide basic detection capability for security organizations and first responders. Identify State & Federal Support capabilities, clarify responsibilities Stockpile radiation exposure antidotes. Prepare educational materials to inform the public during and after an attack

15. Radiation Physics �Basics� Ionizing � but a relatively weak carcinogen and mutagen Comprised of particulate & electromagnetic radiation a alpha b beta g gamma x x-rays n neutron Measures of radiation exposure Exposure, absorbed dose, dose equivalent Internal versus External Exposure Time, Distance, Shielding

16. Radiation Background Several sources Cosmic Terrestrial Anthropogenic

17. RDD Likely Impacts Expected to be terror and an expensive clean-up Contamination of Victims & Environment Effect on Emergency Response Societal Effects Possible Benefits!?

18. Contamination - Victims and Environment Likely to have zero to small number of fatalities within the immediate deployment area Injuries from blast effects most significant Stress-related injuries Moderate to wide-spread contamination

19. Effect on Emergency Response Immediate, radiation-related health effects unlikely Depends on size of RDD, location, conditions Assessment of high radiation level can be made quickly Concern: radioactive contamination may slow response Most important: Treat conventionally wounded first Decontaminate later Protect sensitive populations Public Health Sector Preparedness Prevent �worried well� from impacting system Triage where necessary

20. Societal Effects Potential for initial public panic Concern whether large-scale relocation needed Economic Impact Potentially enormous, both business and personal Protracted societal distraction Political capital expended on clean-up priorities Large governmental clean-up costs Health Effects Psychological effects Increased cancer risk Long-term environmental monitoring

21. Possible Benefits!? Force resolution of radioactive waste clean-up and disposal issues, including driving down disposal costs Educate lay public about radiation risk Tighter hazardous materials controls � reduce accidents Hormesis?!

22. Post-Event Clean-Up Possible to clean-up to pre-event levels? Probably not But health can be protected Economic costs and use restrictions

23. Radioactive Material Characteristics Detection Cannot detect with senses Requires specialized equipment and training Physical form Initially, an airborne solid, dust or gas. Will adhere to surfaces, may dissolve in water. May re-suspend over time Persistence Depends on the �half-life� Environmental transport depends on chemistry, but also physical factors Both dilution and bio-concentration

24. Radioisotope Candidates 137Cs 60Cu 192Ir 226Ra 241Am 239Pu Uranium 3H Irradiators & industrial sources Irradiators Irradiators & industrial sources Irradiators & industrial sources Industrial sources Industrial sources Industrial sources Research, medical, consumer

25. Health Effects Cannot feel or sense an exposure of any magnitude Acute Radiation Syndrome LD50 � approx 300 rad (3Gy) adult, untreated Latency period - characteristic of radiation-induced carcinogenesis Low level exposure - increased risk of cancer

26. Acute Effects Acute Radiation Syndrome (ARS) Nausea, vomiting and diarrhea Cataracts Hair loss LD50 � approx 300 rad (3Gy) adult, untreated Loss of white blood cells Radiation cataracts (lens opacity) Death

27. Low Level Effects Genetic Effects Cancer risks among the atomic-bomb survivors Site-specific cancer deaths Leukemia risks among atomic-bomb survivors Benign tumors: uterus, parathyroid, thyroid Deaths due to non-cancer disease Effect on cholesterol levels, fertility, growth Chromosome aberrations in white blood cells Mutation in blood cells Effects upon the immune system Psychological effects Hormesis

28. How To Know When an RDD is Used? Unexplained deaths of otherwise healthy individuals, ARS symptoms Suspicious explosion or fire, forensics Detection by emergency services Intelligence services Specialized detection equipment, monitoring stations Announcement or claim of perpetrators

29. Treatment Guidelines � Acute NCRP65 AFRRI � Biodosimetry Assessment Tool VA � Pocket Card

31. Patient Management and Treatment � Low Level Exposures Treat life-threatening conditions FIRST Remove Clothing Decontaminate Copious water with mild soap Do not use abrasives or brushes

32. Healthcare Personnel Protection Triage and admitting may need PPE Unless patients are very �hot�, exposure to providers should be minimal See: webcast available on the CDC website Response to Nuclear and Radiological Terrorism

33. Radiation Detection Environmental Monitors Site/Station Monitors Portable Equipment Radiation Safety Departments Laboratories

34. Technical Assistance � RAP map

35. Selected References NCRP Report 138, Management of Terrorist Events Involving Radioactive Material NCRP Report 65 Management of Persons Accidentally Contaminated with Radionuclides Google it!

37. Internet Resources (1) National Safety Council, Environmental Health Center. Link for radiation at: http://www.nsc.org/ehc/rad/radbroch.htm Centers for Disease Control, Emergency Preparedness & Response, Radiation Emergencies http://www.bt.cdc.gov/radiation Radiation Emergency Assistance Center/Training Site http://www.orau.gov/reacts

38. Internet Resources (2) Department of Homeland Security http://www.ready.gov/radiation.html American College of Radiology Disaster Preparedness for Radiology Professionals: Response to Radiological Terrorism http://www.acr.org/departments/educ/disaster_prep/disaster-planning.pdf

39. Internet Resources (3) howstuffworks http://science.howstuffworks.com/dirty-bomb.htm Radiation Effects Research Foundation http://www.rerf.or.jp Health Physics Society http://www.hps.org International Atomic Energy Agency http://www.iaea.org

40. Internet Resources (4) Armed Forces Radiobiology Research Institute http://www.afrri.usuhs.mil Virtual Naval Hospital Initial Management of Irradiated or Radioactively Contaminated Personnel http://www.vnh.org/BUMEDINST6470.10A/TOC.html

41. Other Resources RAND http://www.rand.org Other Sources of Information OHSA, DOE, EPA, NRC State Health and Environment Depts. Academic Centers for Public Health Preparedness

42. Thank you! The New Jersey Center for Public Health Preparedness at UMDNJ www.NJCPHP.org email: Carl.Schopfer@UMDNJ.edu